{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T12:48:20Z","timestamp":1782478100811,"version":"3.54.5"},"reference-count":107,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Young adults with hip pathology present a therapeutic challenge requiring careful consideration of treatment options that will affect decades of future function. Historically, the orthopedic community has maintained a strong preservation bias, often pursuing multiple preservation attempts before considering arthroplasty because of concerns about implant longevity. This narrative review critically examines current evidence regarding hip preservation surgery and total hip arthroplasty in young adults to inform evidence-based decision making. The literature reveals that successful hip preservation requires a narrow therapeutic window defined by preserved articular cartilage, accurate structural diagnosis, and appropriate patient selection. Clinical and imaging predictors, including joint space narrowing below 2 mm, T\u00f6nnis grade 2 or higher osteoarthritis, bipolar chondral damage, and mechanical symptoms, reliably identify patients unlikely to benefit from preservation. Concurrently, advances in bearing surfaces\u2014particularly highly cross-linked polyethylene and ceramics\u2014have dramatically improved arthroplasty outcomes, with contemporary data demonstrating 10-year survivorship exceeding 90% in patients younger than 55 years. Modern total hip arthroplasty delivers consistent pain relief and functional improvement that often exceeds preservation outcomes in appropriately indicated patients. This review proposes a decision-making framework emphasizing that treatment selection should be guided by objective disease characteristics rather than age-based algorithms, optimizing long-term outcomes while minimizing unnecessary morbidity.<\/jats:p>","DOI":"10.1097\/bh9.0000000000000052","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T04:00:21Z","timestamp":1779076821000},"page":"28-36","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking preservation: The case for timely hip arthroplasty in young adult hip pathology"],"prefix":"10.1097","volume":"84","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1807-1926","authenticated-orcid":false,"given":"Utkarsh","family":"Anil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0681-7014","authenticated-orcid":false,"given":"Ran","family":"Schwarzkopf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"R1-20260626","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1503\/cjs.013118","article-title":"Long-term outcomes of total hip arthroplasty in patients younger than 55 years: a systematic review of the contemporary literature","volume":"62","author":"Mei","year":"2019","journal-title":"Can J Surg"},{"key":"R2-20260626","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/jhps\/hnw050","article-title":"Can hip arthroscopy in the presence of arthritis delay the need for hip arthroplasty?","volume":"4","author":"Viswanath","year":"2017","journal-title":"J Hip Preserv Surg"},{"key":"R3-20260626","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1016\/S0140-6736(17)30059-4","article-title":"The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study","volume":"389","author":"Bayliss","year":"2017","journal-title":"Lancet"},{"key":"R4-20260626","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1007\/s11999-013-3377-9","article-title":"What is the prognosis of revision total hip arthroplasty in patients 55 years and younger?","volume":"472","author":"Adelani","year":"2014","journal-title":"Clin Orthop Relat Res"},{"key":"R5-20260626","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.1007\/s11999-013-2975-x","article-title":"Has total hip arthroplasty in patients 30 years or younger improved? 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